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Original research
Three dimensional CT angiography versus digital subtraction angiography in the detection of intracranial aneurysms in subarachnoid hemorrhage
  1. Charles J Prestigiacomo1,2,3,
  2. Aria Sabit4,
  3. Wenzhuan He1,
  4. Pinakin Jethwa1,
  5. Chirag Gandhi1,2,
  6. Jonathan Russin5
  1. 1Department of Neurological Surgery, UMDNJ, Newark, New Jersey, USA
  2. 2Department of Radiology, UMDNJ, Newark, New Jersey, USA
  3. 3Department of Neurology, UMDNJ, Newark, New Jersey, USA
  4. 4Ventura Neurosurgical Associates, Ventura, California, USA
  5. 5Department of Neurological Surgery, Los Angeles, California, USA
  1. Correspondence to Dr C J Prestigiacomo, Department of Neurological Surgery, Radiology and Neurology, University of Medicine and Dentistry of New Jersey, 90 Bergen Street, Suite 8100, Newark, NJ 07101, USA; c.prestigiacomo{at}


Introduction Ruptured intracranial aneurysms are responsible for over 90% of cases of spontaneous subarachnoid hemorrhage (SAH). Conventional digital subtraction angiography (DSA) remains the gold standard for diagnosing the source of SAH. A prospective study is presented wherein SAH patients underwent three dimensional CT angiography (CTA) prior to DSA in order to assess the specificity and sensitivity of this non-invasive modality to detect aneurysms.

Methods 179 consecutive patients with spontaneous SAH presented over 36 months, as identified by screening CT and CTA. Patients with negative CTA findings underwent DSA within 24 h of presentation. All patients who were determined to have angiographically negative SAH underwent follow-up DSA 2 weeks later.

Results Of the 179 patients screened by CTA, 13 (7%) were negative for aneurysms or other vascular lesions (arteriovenous malformation or dural fistula) on CTA and underwent DSA. No new lesions were identified on six vessel angiography, resulting in a 0% false negative rate (sensitivity 100%, predictive value 100%). MRI to rule out thrombosed aneurysms and repeat angiography at the 2 week follow-up were negative.

Conclusions Sensitivity and specificity were higher than previously reported, suggesting that CTA may be used as an initial screening tool in lieu of DSA. Further studies are necessary to determine if CTA can supplant DSA in ruling out all forms of vascular disease in idiopathic SAH.

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the UMDNJ IRB Office.

  • Provenance and peer review Not commissioned; externally peer reviewed.